The prevalence of micronutrient intake adequacy is low among rural women in Bangladesh because intake of lack sufficient nutrient dense foods. In Bangladesh, information on dietary diversity among pregnant and lactating women is minimal. BRAC, jointly with A&T undertaken a feasibility study on the integration of maternal nutrition in maternal, neonatal and child health (MNCH) programme, considering that maternal nutrition should receive equal priority as child nutrition (Alive & Trive 2017). Considering the behavioural change focus of the A & T strategy, BRAC Maternal Nutrition Intervention (MNI) project has been concentrated on improving dietary practices, specifically, improved diversity of foods and energy intakes of pregnant women, and improve the intake of calcium and iron/folic acid supplements. The ultimate goal of this project was to reduce maternal malnutrition, morbidity and illness through increased dietary diversity, energy intake, and iron/folic acid and calcium intakes and improve early breastfeeding practices. Under this project, all identified and registered pregnant women in MNCH intervened 10 upazila were received iron-folic acid (IFA) and calcium tablets free of cost. The BRAC’s Shasthya shebika (SS) encourage adequate intake of calories and diverse foods to the pregnant women. During antenatal care (ANC) checkup Shasthya kormi (SK) measure weight and counselled mother and her family members including husband and non-pregnant women and mother-in-law on the correct number of meals per day and conduct a practical demonstration on measuring adequate amounts and diversified food. All registered pregnant women were received one bowl measuring 250 ml to measure their daily required food allowance. However, consumption of recommended foods for pregnant and lactating women has been increased over the period, but consumption of milk and milk products, eggs and yellow/orange fruits or vegetables were decreased. This study therefore, designed to explore reasons behind the low consumption of dietary diversity of pregnant and lactating women of MNI programme areas.

METHODS

Qualitative method was employed in gathering the research information. This study was carried out in two districts (Rangpur and Mymensingh) of Bangladesh during April-May in 2017. In-depth interview (IDI) with both pregnant and lactating women (12), focus group discussion (FGD) with community women (4), informal discussion with fathers (12) and grandmothers (12), key informant interview (KII) with service providers (6) were done to get triangulated information. In addition, all IDI participants were done to observe food practices and family members support towards the mother. This process helped to explore the actual scenario between knowledge and practised behaviour. Four separate interview guides were developed as IDI, semi-structured individual interview, FGD and KII guidelines for three categories of respondents. Field diary and observation checklist were also prepared for the three days observation session. Photos were captured during observation through TAB. All the instruments were pretested at aurban slum before finalisation. Data were analysed manually by applying the thematic framework analysis method. For ethicaL clearance, the proposal was submitted to the ethical review committee of BRAC. Both written and verbal consent was taken before each interview where necessary. Pseudonyms have been used in the report to ensure their privacy.

KEY FINDINGS

Socioeconomic profile of the women FGDs were conducted with a total of 31 young and elder women. Age of the youngest woman in this study was 16 years, while the oldest was 75 years. The majority of mothers were aged between 16-30 years. Findings of this study were that FGD women had varied levels of education ranging from no schooling to SSC. Majority of them were involved in child rearing and housekeeping. A total of 12 IDIs were conducted with both pregnant and lactating women. They were between the ages of 19-35 years during the survey time. Most of them were housewives (n=11). Of the 12 participants, the majority of them had some sort of education. Their husbands were involved in various activities such as farming, van driving, auto-rickshaw driving, business etc. Majority of the participants household income were between BDT 5,000 to 10,000 during the survey time.